AGENDA FOR CHANGE

NHS JOB EVALUATION SCHEME

JOB DESCRIPTION

1.JOB IDENTIFICATION

Job Title: Nurse Practitioner (Unscheduled Care)
Reports to: District Manager
Department, Ward or Section: Emergency Department
CHP, Directorate or Corporate Department: Medical Directorate
Job Reference: SMOUNHSHNURSUNSC05
No of Job Holders: 4
Last Update: May 2013

2. JOB PURPOSE

As a Nurse Practitioner (Unscheduled Care), you will be expected to provide expert clinical case management to children and young people, adults, carers, families and communities within a defined population in the most appropriate environment, whether in the community, on the telephone or in the Primary Care Emergency Centre (PCEC).
  1. To undertake advanced level assessment in order to address undifferentiated illness and injury by using expert knowledge and clinical judgement to diagnose, initiating interventions and negotiate discharge, to refer or follow up arrangements.
  2. To provide health promoting, patient focused, evidence based clinically effective nursing care.
  3. To continually improve patient care pathways, in conjunction with other statutory and voluntary services, for patients, and their carers.
  4. Will be working as part of the wider out of hour’s team but will mainly work in isolation without direct supervision. Responsible for the assessment, planning, delivery and evaluation of high quality health care.
  5. Using a proactive approach to promoting health and wellbeing, detection and prevention of vulnerability, preventing illness, reacting and responding to existing or potential ill health issues and contributing to reduction in unplanned hospital admissions.

3. DIMENSIONS
The post holder will assist in providing an autonomous injury and illness service within their area/ department. This involves triage, assessment, requesting investigations and interpretation of results, diagnosis, treatment, discharge or onward referral to other medical specialties, without always referring to a doctor.
Triage and institute care in the PCEC and community, referring to appropriate agencies within the care family.
Comprehensive management of cases using specialized skills.
Unscheduled care services may be the first point of contact for patients with minor or major injuries and deals with a range of problems from a painful finger to major motor vehicle crashes and patients with multiple traumas. Also cared for are medical patients with conditions varying from a rash to a heart attack. The Nurse Practitioner will request medical support when required always working within his/her own level of competence and within the NMC Code of Professional Conduct.
Expectations:
Post holders will independently assess, treat and discharge a large proportion of patients attending. They will have medical clinical support available on request, and assist medical colleagues with clinical management of patients with major illness and injury.Provide nursing expertise and management of patients in Unscheduled Care.
Provide unscheduled nursing care to patients in their own homes with immediate issues, e.g. medication management, wound care, urinary catheter management to prevent hospital admission.
Assessing, planning and implemention of care of in-patients in Mid Area community hospitals.
Planning and organisation of a broad range of complex activities, some of which are ongoing, which requires the formulation and adjustment of plans or strategies.
To care for patients of all ages including paediatrics and elderly
Provide care for bereaved relatives/carers/ friends
Sudden, sometimes traumatic, death of adults and children
Infection Control
Leading/taking part in research projects within the department
Leading/taking part in delivering teaching and training
Awareness of staff rostering and ability to make best use of resources
Awareness of departments supply levels and correct ordering procedures
Initial care of patients presenting with mental health problems.

4. ORGANISATIONAL POSITION

Area Manager

District Manager Lead Nurse OOHs Clinical Lead

Nurse PractitionerUnscheduled Care (this post)

5. ROLE OF DEPARTMENT

  1. The Mid Area Out of Hours Service provides services for patients of all age groups in Mid and East Ross presenting with sudden / acute illness and patients who have experienced trauma, from minor to major life threatening injuries.
  2. Provides a high quality, safe and supportive environment in order to care for patients, meeting their identified physical and psychological needs.
  3. Provides all primary level out-of hours-care for the local community, including community nursing.
  4. Out of hours medical and nursing service for 2 PCECs and 3 community hospital units serving a population of 100.000 people.

6. MAIN TASKS, DUTIES AND RESPONSIBILITIES

  1. Works as an autonomous practitioner within the Statutes and Guidelines as laid down by the Nursing and Midwifery Council.
  2. Works autonomously as a Nurse Practitioner (Unscheduled Care) adhering to defined unscheduled care guidelines. Assessment, history taking, examination, treatment, request/interpret tests, full comprehensive documentation, prescribe medication within the role of an extended and independent nurse prescriber.
  3. Sets high standards of professional practice and clinical leadership
  4. Involved with the setting and maintaining of standards of care within the agreed guidelines of NHS Highland policies and procedures and ensures adherence to and delivery of a high quality service, whilst developing clinical leadership.
  5. Responsible for assessment of health care needs of patients, involving families / carers and develops, plans, implements and evaluates programmes of care.
  6. Has the ability to organise own workload and adjust priority of changing demands to ensure all needs are met in the care of Out of Hours patients.
  7. With reference to NHS Highland and NMC guidelines, the post holder is accountable to initiate and maintain patient records e.g. Triage / assessment, Nursing Notes, Care Pathways, clinical notes.
  8. Provide support and advice to patients and their families or carers, giving the knowledge required to help them understand and cope with their condition, offering psychological, physical and spiritual support, including health support and accident prevention.
  9. Demonstrate skills within scope of Professional Practice with sound clinical knowledge e.g. ECG recording, I.V. drug therapy, basic plaster of Paris and splint application, urinary catheterisation, venepuncture, cannulation, arterial blood gases, wound management and closure including suturing, skin adhesives and steristrips. Able to identify own limitations and refer to more senior practitioners or medical staff when skill required is beyond scope of practice.
  10. With knowledge and skills in unscheduled care, act as a clinical advisor to junior medical and nursing staff and encourage others to develop their skills ensuring staff are competent to deliver high standards of care e.g. develop role by using evidence based practice and continuously improve own knowledge.
  11. Perform appropriate triage model to undertake an autonomous initial assessment of patient’s health and well being needs, identify care priorities and initiate appropriate treatment or first aid measures, administer analgesia and inform relevant personnel.
  12. Provide nursing expertise and assist medical staff in management of the critically ill or major trauma victims (adults and paediatrics)
  13. Maintain knowledge of Child Protection issues and guidelines.
  14. Undertake appropriate training to administer an identified drug, essential for the Nurse Practitioner (Unscheduled Care) role, within role of an extended and independent nurse prescriber.
  15. To be familiar with the Hospitals’ Major Incident Plan and equipment, taking an active role in preparations and care of multiple casualties received in the event of a major incident or accident occurring.
  16. In absence of reception staff, admit patient on to ADASTRA system once treatment is completed and patient has left department.
  17. Initiate care and investigations of patients presenting with potential cardiac problems if doctor not immediately available i.e. O2 therapy, cannulate, obtain blood samples, ECG
  18. Maintains Department supply and pharmacy levels, undertaking correct ordering procedures and ensure economic use of all resources.
  19. Ensure there is a robust Discharge and Transfer Planning system in operation to ensure the smooth transition of the patient from hospital to home, community facilities, wards, departments or other hospitals and onward referral to day time services.
  20. Maintains effective communications with patients / families / carers and other members of the multidisciplinary team to ensure appropriate information is shared and patient needs met.
  21. Participates in developing and maintaining a positive learning environment. Undertake teaching of students, nursing colleagues and other members of the multidisciplinary team and participate in orientation and student mentorship programmes, encourage staff with Personal Development Plans to facilitate ongoing development.
  22. Work with all team members to ensure a high standard of cleanliness throughout the department promoting good standards of hygiene in conjunction with the Control of Infection Team to ensure infection rates are minimised.
  23. Promote the health and safety of patient, staff and visitors within the ward area and during transfer to other wards and departments.
  24. Ensure safe custody of patients’ valuables following NHS Highlands policies, with accurate and concise documentation
  25. Seek medical decision making support within the department or via telephone when required within the community or request GP attendance, or ambulance transfer to hospital.
  26. Participate, with the Charge Nurses, in the implementation and audit of standards of clinical care and comment on proposed changes to practices / procedures in own department to ensure high standard of patient care, promote evidence based practice and the attainment of healthcare governance requirements.
  27. Adhere to NHS National, NHS Highland and NMC policies and codes of practice including record keeping / care planning, health and safety, infection control, PIN guidelines and standing financial instructions.
  28. Demonstrate highly developed clinical nursing skills and act as a mentor for student nurses and clinical advisor and educator to unqualified team members.
  29. Work in a professional and cooperative manner within a multi-disciplinary team, liaising with Social Work Department, District Nursing Service and other agencies as required.
  30. Identifying/reacting to mechanical breakdown, fabric of building communications failures.

MANAGERIAL

1Consultation with the Clinical Lead to develop and support initiatives in order to deliver enhanced levels of care and client satisfaction.
2Supports managers and the Clinical Lead in managing and driving change and development through planning, communication and action within the multidisciplinary team to ensure objectives are met.
3Consultation with regards to development and implementation of new local guidelines.
4Facilitates the work of nurses and others through knowledge, support and advice, ensuring standards of care are met, monitored and maintained.
5Assist Clinical Lead in maintaining effective communication systems in the service ensuring staff access relevant documented minutes and information and are involved and informed of all agreed decisions.
6Assists in Health and Safety policies and procedures being maintained and accurate and up to date records are kept e.g. Completion of Risk assessments, Moving and Handling, Control of Substances Hazardous to Health, Mandatory training needs, completing of Datix forms.
7In conjunction with Charge Nurses, actively involved in recruitment, by short-listing and interviewing junior staff.
8Assists in implementing and managing PIN Guidelines and liaises with the Charge Nurses on particular issues / difficulties.
9Actively develop and maintain a positive learning environment, participating in teaching programmes for nursing, allied health professionals, patient / carers using resources available.
10Assists Charge Nurses to create an environment for research based nursing practice, participating in and encouraging others to undertake audit and research to improve local practice as designated by the Lead Nurse following Clinical Effectiveness Guidelines.
11Initiates informal critical incident debriefing after a stressful incident.
12Promotes and maintains good relationships within the service and with staff of all disciplines throughout the Area and NHS Highland. Actively participates in relevant meetings, promoting the department, unscheduled care nursing and the nursing profession in general.
13Undertake staff rosters when required to ensure safe skill levels and effective use of resources.
Responsible for procurement and maintenance of all physical assets or supplies for the Out of Hours service

7a. EQUIPMENT AND MACHINERY

Utilises technical equipment, calibrating when required, checking for faults and ensuring regular maintenance. Is expected to have knowledge of all equipment used in the department and will use
equipment once provided with training but may not have daily clinical involvement.

EQUIPMENTUSE

Intravenous Pumps, syringe drivers,Deliver prescribed drugs / fluids safely
I.V. lines, venflons, butterfly devices,}
Syringes, needles }
Arterial linesInvasive monitoring, essential for
Central Venous Pressure linesacutely ill or trauma patient
Non invasive monitoring equipment for:Measure and observe patients condition
Blood pressure, temperature, pulse,
Oxygen saturations, CO2, telemetry
Blood Gas AnalyserAccurate assessment of arterial blood
Oxygen equipment: Deliver correct prescribed oxygen
Flowmeters, masks, humidificationconcentrations
Nasal cannulae
Pneupac IPPV ventilatorAid patient’s respiration / breathing
BPAP machine}
Various suction devicesDrain fluid – mouth / upper airway
Chest DrainsDrain fluid /air from thorax
Nebulisers, Volumatic / spacersDeliver prescribed respiratory therapy
Pulmo-aid
Peak flow meterGuide measurement of lung function
Entonox equipment and delivery systemDeliver inhaled analgesia
Resuscitation equipment including:
Defibrillator, Laryngoscope, E.T tubesFor use in resuscitation of acutely ill
Ambu bag, laryngeal masksor trauma patient
Difficult Intubation TrolleySpecialist anaesthetic equipment
Nasogastric tubesDrain gastric contents
Urinary catheters:
Urethral, suprapubicDrain and measure urine
ECG machineRecord heart rhythm
Patient Trauma Trolley, PAT slideSafe transfer and movement of patients
Wheelchairs, Hoist, Slides sheets,}
Monkey poles, Underarm / elbow crutches}
Stiff cervical collars, head huggersHelp protect neck after injury
Major Incident Equipment including:
Amputation setsAmputation of limbs at incident site
RucksacksResuscitation equipment
Documentation packsEssential documentation for M.I. use
High visibility clothing, helmets etcUse by staff attending incidents
Electric DeSouter sawRemoval of plaster and synthetic casts
Plaster scissors and shearsRemoval of plaster casts
Slit lamp, ophthalmoscopeExamination of eyes
AuroscopeExamination of ears
Doppler machineObserve for arterial pulse
GlucometerMonitor blood glucose
Alcohol breathalyser monitorMonitor blood alcohol levels
Ring cuttersRemoval of rings from injured fingers
Ambulance radio transmitterVerbal contact with ambulances
Chute SystemTransportation of items
Pregnancy testing kits
Digital Camera Taking appropriate consented clinical photographs
Patient call system
Staff personal safety alarms
Overhead operating/ portable examination lightsUse in technical /delicate procedures
Computers:
PAS system, Intranet,
Toxbase, ADASTRATAInformation on effects of poisons
Results ReportingObtain patients clinical results
Furniture:
Beds, bedside lockers, chairs
Spenco mattressesUse on beds and trolley
Help prevent pressure sores
Fluid Warming CupboardWarm I.V.fluids for resuscitation
Blood FridgeStore blood for urgent use
Heated Blanket cupboardStore warm bedding
CarTravel to visit community based patients
7b. SYSTEMS
  1. Maintains patient records in accordance with the NMC guidelines and NHS Highland standards.
  2. Ensure correct use of computerised system for the out of hours services.
  3. Participates in clinical audit
  4. Assists in maintenance of accurate staff records relating to PIN guidelines e.g. leave through annual leave, sick leave, employee friendly policies, training, e-KSF and PDPs .
  5. Adhere to all service and office systems for example, reorganise rotas for sudden cover requirements, sickness / absence, change in workload, training etc
  6. Utilise communication systems for example, meetings, communication book, and multi-disciplinary team meetings.

8. ASSIGNMENT AND REVIEW OF WORK

  1. The workload is determined by the needs of the service and the post holder will delegate / allocate work appropriately to the nursing teams.
  2. The Nurse Practitioner (Unscheduled Care) will look to the District Manager and Lead Nurse for guidance in their professional management, work review and formal appraisal of performance. When undertaking Nurse Practitioner (Unscheduled Care) duties the post holder will seek clinical guidance from senior medical staff as appropriate.
  3. Regularly discusses all aspects of OOHs management with managers, attends and participates in speciality meetings, staff meetings, nurse development meetings.
  4. Is expected to anticipate problems / needs and take steps to resolve them in the absence of more senior staff, involving appropriate colleagues e.g. , Consultant, Bed Manager, Duty Manager
  5. Support is available to and from all members of the multidisciplinary team as required.
  6. In conjunction with the Charge Nurses, ensures policies are initiated / revised, developed, implemented and reviewed regularly.
  7. When allocated to triage/manage patients within own sphere of competencies. Discuss if appropriate with medical colleagues, referrals from NHS 24 agreeing the most appropriate practitioner to respond to patients’ needs.
  8. In conjunction with the District Manager, Clinical Educator and OOH doctors taking the lead in unscheduled care, identify own education, training and support needs via the Personal Development Plan process, access clinical supervision and action learning and participate in in-service education.
  9. Works within a duty rota developed for the Mid Area OOH Service.
  10. Accountable for his / her own actions without direct supervision and for the care provided by unqualified staff.

9. DECISIONS AND JUDGEMENTS
  1. The ability to quickly assess and respond to patients needs in emergency situations.
  2. The post holder has to demonstrate rapid decision-making skills in an ever changing and unpredictable environment.
  3. Post holder will be responsible for ensuring that clinical practice meets the standard of care set by the NMC and NHSH, and that non compliance with these standards is managed in accordance with the appropriate policies and procedures.
  4. Provision of professional advice to registered/ unregistered staff and students and an ability to recognise own limitations and the requirement for appropriate referral.
  5. Judgments involving highly complex facts or situations, which require the analysis, interpretation and comparison of a range of options.
  6. Assessment of patients’ complex needs (physical, psychological, social and spiritual) to establish a change in condition, inform clinical decision making and plan care.